Facts read from aanpcert.org and 2 more · last checked Nov 7, 2026
Endocrine questions on the family exam are mostly type 2 diabetes and thyroid tests, with osteoporosis and the occasional adrenal or pituitary finding. The skills are reading a lab pattern and choosing the drug the patient's other conditions call for.
Practice questions
60 questions written to the FNP-C outline; each choice is explained once you pick.
Type 2 diabetes: diagnosis, the first drug, drug choice with heart, kidney or heart failure disease, starting insulin, complication screening.
Kidney function in diabetes: eGFR, albuminuria and drug dosing.
Thyroid: TSH-first testing, hypo- and hyperthyroid patterns, nodules, follow-up after treatment.
Bone: osteoporosis therapy and its response.
Adrenal and pituitary: testing for cortisol excess, incidental adrenal masses, prolactin.
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16 adult endocrine questions
0 / 16 answered16 questions
Tap an option: why each one is right or wrong appears under it.
Adult endocrine care
A 71-year-old woman has received denosumab every 6 months for 5 years for osteoporosis. She has had no fractures, and her total hip T-score has improved from −2.7 to −2.1. She wants to stop the injections. Her creatinine clearance is 70 mL/min. Which plan is most appropriate?
Stopping denosumab causes a rebound rise in bone turnover and a risk of multiple vertebral fractures, so a bisphosphonate (often zoledronic acid) is started about 6 months after the last injection.
Switching to calcium and vitamin D does not prevent the rapid bone loss that follows denosumab withdrawal.
Raloxifene is a weak antiresorptive that does not protect the spine against denosumab rebound and adds venous thrombosis risk.
Drug holidays apply to bisphosphonates, which stay bound in bone; denosumab leaves no residual effect, so a holiday leaves her unprotected.
A 65-year-old woman with type 2 diabetes for 15 years reports early satiety, bloating, and vomiting of undigested food several hours after meals. Her glucose readings fluctuate widely. Upper endoscopy shows no obstruction. Which test confirms the suspected diagnosis?
A barium series looks for structural lesions, and endoscopy has already excluded obstruction; it does not measure how fast the stomach empties.
CT evaluates masses and obstruction, which endoscopy has already addressed; it does not show delayed emptying.
Once obstruction is excluded, a 4-hour solid-meal gastric emptying scintigraphy confirms gastroparesis, a long-term autonomic complication of diabetes.
The urea breath test detects H. pylori, which causes dyspepsia and ulcers but not delayed emptying with vomiting of food eaten hours earlier.
A 40-year-old woman has heat intolerance, weight loss, and palpitations. On examination the thyroid is diffusely enlarged. Which additional finding best supports Graves disease?
A small, firm gland suggests chronic autoimmune (Hashimoto) thyroiditis, which usually causes hypothyroidism rather than heat intolerance and weight loss.
A tender, painful gland after a viral illness suggests subacute (de Quervain) thyroiditis, which can also cause thyrotoxicosis but without a bruit.
A bruit over a diffusely enlarged gland reflects the increased blood flow of Graves disease, driven by TSH-receptor antibodies.
Slow relaxation of the ankle reflex is a sign of hypothyroidism.
A 30-year-old woman reports palpitations and a neck lump. On thyroid palpation, which finding is most concerning for thyroid carcinoma rather than a benign goiter?
A tender gland after a viral illness suggests subacute thyroiditis.
A solitary hard nodule fixed to surrounding tissue is the palpation finding most concerning for thyroid carcinoma and calls for TSH, ultrasound, and possible fine-needle aspiration.
Multiple soft nodules that move with swallowing suggest a benign multinodular goiter.
Diffuse, nontender enlargement suggests a benign goiter or Graves disease, not a malignant nodule.
A 55-year-old man has a 2.5-cm left adrenal mass found incidentally on CT done for kidney stones. It has a density of 25 Hounsfield units. He has hypertension controlled on one drug and a normal potassium level. Which evaluation is most appropriate?
Biopsy can provoke a hypertensive crisis in an undiagnosed pheochromocytoma and rarely helps; it is not part of the routine workup.
Every adrenal incidentaloma needs hormone testing: metanephrines for pheochromocytoma and a 1-mg overnight dexamethasone suppression test for autonomous cortisol, plus an aldosterone-to-renin ratio when hypertension is present.
Lack of symptoms does not exclude a functioning tumor; mild autonomous cortisol secretion and pheochromocytoma are often silent.
Repeat imaging without hormone testing misses functioning tumors; and a density over 10 Hounsfield units already needs further imaging characterization.
A 70-year-old woman on osteoporosis therapy is evaluated. Which finding indicates the need to modify treatment?
A normal serum calcium is expected and reassuring; it does not show treatment failure.
Occasional joint pain is unrelated to how well osteoporosis treatment is working.
Stable bone density on therapy is an acceptable response; the goal is to prevent fractures, not to raise the T-score every year.
A fragility fracture during treatment suggests an inadequate response and prompts a review of adherence, how the drug is taken, secondary causes, and a possible change of agent.
A 34-year-old woman with Graves disease received radioactive iodine 3 months ago. She takes atenolol and feels better but still has mild tremor. Heart rate is 88/min, free T4 is mildly elevated, and TSH remains suppressed. She has no eye disease. What is the most appropriate management?
Radioactive iodine takes weeks to months to work; with improving, mildly elevated free T4 at 3 months, she continues beta-blockade and has thyroid tests every 4 to 6 weeks.
Surgery is not needed while the first radioactive iodine dose is still taking effect.
Levothyroxine starts once free T4 falls below normal; with a still-elevated free T4 it would worsen thyrotoxicosis.
Retreatment is considered when hyperthyroidism persists about 6 months after radioactive iodine; at 3 months it is premature.
A 71-year-old man with type 2 diabetes taking glipizide and a recent drop in appetite is found by his wife with new right-sided weakness and slurred speech 40 minutes ago. He is sweaty and confused. BP is 150/88 mmHg. Fingerstick glucose is 38 mg/dL. What is the most likely cause of his deficits?
A glucose of 38 mg/dL in a patient taking a sulfonylurea who is eating less explains sweating, confusion, and focal deficits; hypoglycemia is a classic stroke mimic, which is why glucose is checked before stroke treatment.
Ischemic stroke stays possible only if the deficit persists after the glucose is corrected; treating it as a stroke first skips a reversible cause.
Todd paralysis follows a seizure, and nothing suggests one occurred.
Hypertensive encephalopathy needs much higher pressures and causes global rather than focal signs.
A 46-year-old man is diagnosed with type 2 diabetes today. He has no visual complaints. According to ADA Standards of Care, when should he have his first dilated eye examination or retinal imaging?
Eye screening does not depend on the A1C level; even well-controlled patients need it.
Retinopathy is silent until it is advanced, so waiting for visual symptoms defeats screening.
The 5-year delay applies to type 1 diabetes, where retinopathy rarely appears earlier; using it for type 2 is the error.
In type 2 diabetes hyperglycemia is often present for years before diagnosis, so ADA advises a dilated eye exam or retinal imaging at or soon after diagnosis.
A 67-year-old man with type 2 diabetes has taken metformin for 12 years. He has 3 months of numb feet, unsteadiness in the dark, and falls. He has lost vibration and position sense in both feet, a positive Romberg sign, brisk knee reflexes, and bilateral extensor plantar responses. Hemoglobin is 10.9 g/dL with an MCV of 109 fL. What is the most likely diagnosis?
Loss of vibration and position sense with brisk reflexes and Babinski signs, plus macrocytic anemia after years of metformin, points to vitamin B12 deficiency causing subacute combined degeneration of the dorsal and lateral columns.
Tabes dorsalis also causes sensory ataxia, but with absent reflexes, lightning pains, and Argyll Robertson pupils.
Diabetic neuropathy lowers reflexes and does not cause upper motor neuron signs or a macrocytic anemia.
Cervical myelopathy can combine sensory loss with upper motor neuron signs, but it does not explain the macrocytic anemia, and the neck symptoms are absent.
A 62-year-old Black man with type 2 diabetes has a serum creatinine of 1.6 mg/dL on two occasions 3 months apart. The NP needs to stage his chronic kidney disease. Which approach is currently recommended to estimate his glomerular filtration rate?
Cockcroft-Gault estimates creatinine clearance and still appears in some drug labels, but it is not used to stage CKD.
The race coefficient overestimated GFR in Black patients and delayed CKD diagnosis and referral; it has been removed from the recommended equation.
The 2021 CKD-EPI creatinine equation uses age and sex without a race term and is recommended for estimating GFR and staging CKD (NKF/ASN task force; KDIGO 2024); cystatin C can be added to confirm.
Creatinine alone misleads because it depends on muscle mass, age, and sex; a level of 1.6 mg/dL means a different GFR in different people.
A 64-year-old man with diabetes is evaluated after foot-care education. Which finding indicates the need for reinforcement?
Moisturizing dry skin while keeping the spaces between the toes dry is correct foot care.
Daily inspection of both feet is exactly what ADA advises for people with diabetes.
Cutting nails too short or rounding the corners risks ingrown nails and infection in a foot with neuropathy, so improper nail-trimming technique needs re-teaching.
Changing socks regularly keeps the feet dry and is good practice.
A 38-year-old woman has gained 12 kg in a year and has new wide purple abdominal striae, easy bruising, weakness when climbing stairs, and new hypertension. She uses no glucocorticoids by any route. Which initial test is most appropriate?
Imaging comes only after biochemical confirmation and an ACTH level; pituitary incidentalomas are common and can mislead.
Wide purple striae, bruising, and proximal weakness make Cushing syndrome likely; after exogenous steroids are excluded, a first-line screen is late-night salivary cortisol (or 24-hour urine free cortisol or the 1-mg dexamethasone test).
The cosyntropin test looks for adrenal insufficiency; it does not detect cortisol excess.
A single morning cortisol overlaps with normal values and cannot show the loss of the normal evening fall that defines Cushing syndrome.
A 32-year-old man has had low libido and erectile dysfunction for a year and recent headaches. Prolactin is 480 ng/mL, testosterone is low, and LH is low. MRI shows a 2.2-cm pituitary macroadenoma without optic chiasm compression, and his visual fields are normal. He takes no medications. Which is the most appropriate initial treatment?
Radiation is a last resort for tumors that fail medical therapy and surgery, and it causes delayed hypopituitarism.
A prolactin level this high with a macroadenoma means a prolactinoma; a dopamine agonist, preferably cabergoline, is first-line and usually shrinks the tumor and restores testosterone.
Surgery is for prolactinomas that do not respond to or cannot tolerate a dopamine agonist, or for apoplexy; it is not the first step.
Starting with testosterone treats the symptom and leaves the tumor untreated; lowering prolactin often restores the gonadal axis on its own.
A 72-year-old woman has a TSH of 6.8 mIU/L found on routine testing, with a normal free T4. She has no symptoms of hypothyroidism, is not pregnant, and has no previous thyroid results. Which is the most appropriate next step?
Ultrasound is for a palpable nodule or goiter; it does not help interpret a mildly raised TSH.
Full-dose levothyroxine for an unconfirmed mild TSH rise in an older adult risks overtreatment, atrial fibrillation, and bone loss.
Uptake scans evaluate hyperthyroidism, not a mildly elevated TSH.
A single mildly raised TSH with a normal free T4 is often transient; it is confirmed with repeat testing in about 2 to 3 months before any treatment decision, and TSH runs higher with age.
A 48-year-old man is newly diagnosed with type 2 diabetes. He has 2 months of thirst, frequent urination, and a 5-kg weight loss. A1C is 11.8% and random glucose is 365 mg/dL; urine ketones are negative and he is not acidotic. Which initial treatment is most appropriate?
Metformin lowers A1C by about 1 percentage point, far short of what he needs, and it does not reverse the catabolic state quickly.
A DPP-4 inhibitor alone lowers A1C modestly and is not enough for symptomatic hyperglycemia with weight loss.
Lifestyle change alone is not enough at this level of hyperglycemia with weight loss and risks progression to a hyperglycemic crisis.
Symptomatic hyperglycemia with weight loss and an A1C above 10% or glucose of 300 mg/dL or higher is a catabolic state; ADA advises starting insulin, with metformin, and simplifying later as glucose toxicity resolves.
A running total sits here; it fills in after your last pick.
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Diabetes and thyroid errors that keep recurring
One abnormal glucose as a diagnosis. Without unequivocal hyperglycemia, the ADA Standards of Care require two abnormal results, from one sample or two: A1C 6.5% or higher, fasting glucose 126 mg/dL or higher, or 2-hour glucose 200 mg/dL or higher on an oral glucose tolerance test.
An A1C that cannot be trusted. Conditions that change red cell turnover (some anemias, recent transfusion or blood loss, hemoglobin variants, advanced CKD) distort it; ADA directs you to plasma glucose criteria instead.
Choosing by A1C alone. With atherosclerotic disease, heart failure or CKD, ADA points to an agent with proven heart or kidney benefit, from the SGLT2-inhibitor or GLP-1 RA classes, whatever the A1C and whether or not metformin is on board.
Metformin and the kidneys. FDA labeling contraindicates it below an eGFR of 30 and advises against starting it between 30 and 45.
Thyroid tests out of order. TSH comes first; free T4 is added when TSH is abnormal. Levothyroxine is taken apart from calcium and iron, which reduce absorption.
Biotin. High-dose biotin supplements interfere with many immunoassays, thyroid tests included, and can produce falsely abnormal results (FDA safety communication).
The current one. ADA revises its Standards of Care every year, and NPCB does not say which edition its items follow, so recent changes in drug choice are worth knowing.
Is type 2 diabetes in teenagers covered here?
No. This page is written for adults; endocrine problems of children and teenagers belong to pediatric primary care (CPNP-PC).